Tuberculosis in Older Adults: Seattle and King County, Washington

Toren, Katelynne Gardner; Spitters, Christopher; Pecha, Monica; Bhattarai, Sanju; Horne, David; Narita, Michiko

doi:10.1093/cid/ciz306

Cited by 13 publications

(21 citation statements)

References 14 publications

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“…A smaller proportion of patients with co-morbidities in this study may unravel advanced age as an independent risk factor for mortality during TB treatment. For example, the prevalence of diabetes among older TB patients aged ≥ 65 and ≥ 75 years are is 17% for both (26 of 152 and 20 of 117, respectively) in the present study, which is notably lower than that of the patients aged ≥ 65 years in the King County study (40%, 44 of 111) [ 11 ] and a report from France showing the prevalence of diabetes in TB patients aged ≥ 75 years was 29.1% (32 of 110) [ 9 ]. Similarly, the prevalence of co-morbidities such as end-stage renal disease, HIV, and non-HIV-related immunosuppression were also low in the same age group of this cohort.…”

Section: Discussioncontrasting

confidence: 55%

“…Those aged ≥ 75 years were also at increased risk of adverse events due to TB medications. Older TB patients have been reported to have a higher risk of adverse events [ 10 , 15 ]. While a prior study by our group in King County, Washington, USA (‘the King County study’) found that those aged ≥ 75 years were likely to have adverse events later in therapy compared with other age groups [ 11 ], there were no significant differences in time to last adverse events across the age groups in this cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Older TB patients have been reported to have a higher risk of adverse events [ 10 , 15 ]. While a prior study by our group in King County, Washington, USA (‘the King County study’) found that those aged ≥ 75 years were likely to have adverse events later in therapy compared with other age groups [ 11 ], there were no significant differences in time to last adverse events across the age groups in this cohort. The close observation during hospitalization that is common practice in Japan may have increased early detection and intervention to prevent late-onset adverse events during the subsequent treatment period.…”

Section: Discussionmentioning

confidence: 99%

“…Second, until 2018, the Japanese TB treatment guidelines recommended excluding pyrazinamide (PZA) from TB regimens for patients older than 80 years of age [ 7 ]. Cautious recommendations for the use of PZA in patients aged over 75 years are in the US guideline [ 8 ] and the exclusion of PZA among older patients is common worldwide [ 9 – 11 ]. Exclusion of PZA among patients aged 80–84 years and > 90 years in 2009–2014 in Japan was > 75% and 90%, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary Tuberculosis in Older Adults: Increased Mortality Related to Tuberculosis Within Two Months of Treatment Initiation

et al. 2021

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Background The proportion of tuberculosis (TB) patients who are older adults is increasing worldwide. Nearly 60% of TB patients in Japan are 70 years or older, and the TB incidence rate in Japan is one of the highest among high-income countries. The previous TB treatment guidelines prior to 2018 in Japan recommended excluding pyrazinamide (PZA) from the initial regimen for patients aged over 80 years. Objectives We aimed to examine differences in TB treatment outcomes among different age groups, and between those who received PZA and those who did not. Methods We performed a retrospective cohort study of patients with pulmonary TB who were managed at a single medical center in Japan. We compared treatment outcomes and adverse events that resulted in treatment interruption across the age groups. Results Of 246 patients, 117 (48%) were aged 75 years or older. Compared with patients aged < 74 years, those ≥ 75 years were less likely to have PZA in the initial regimen (53.0% vs 89.9%; p < 0.0001), more likely to die during treatment (38.5% vs 6.2%; p < 0.0001), and more likely to experience adverse events (30.8% vs 19.4%; p < 0.05). The mortality rate related to TB at 2 months after TB treatment initiation was 28% in those aged ≥ 84 years. Furthermore, among patients aged ≥ 84 years, those who did not receive PZA were significantly more likely to die than those who did (65.8% vs 36.8%; p < 0.05). Conclusions Patients aged ≥ 75 years with pulmonary TB experienced increased mortality related to TB during treatment and more frequent adverse events than younger patients, even though PZA was often avoided among older patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00880-4.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulmonary Tuberculosis in Older Adults: Increased Mortality Related to Tuberculosis Within Two Months of Treatment Initiation

et al. 2021

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“…Because pyrazinamide is most frequently responsible for liver damage [62,65,66], the American Thoracic Society, the Centers for Disease Control and Prevention and the Infectious Diseases Society of America assess that in the elderly with a moderate TB disease with low risk of drug resistance, the benefits of pyrazinamide use in the initial dosing regimen is less than the risk of serious adverse events [62,67]. Therefore, American guidelines do not recommend the use of pyrazinamide during the intensive phase in patients aged >75 years for moderate disease and low resistance risk [68,69].…”

Section: Treatment Tolerancementioning

confidence: 99%

Tuberculosis in the Elderly

Diamantis

Wazières

Gallien

2021

JCM

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The tuberculosis (TB) epidemic is most prevalent in the elderly, and there is a progressive increase in the notification rate with age. Most cases of TB in the elderly are linked to the reactivation of lesions that have remained dormant. The awakening of these lesions is attributable to changes in the immune system related to senescence. The mortality rate from tuberculosis remains higher in elderly patients. Symptoms of active TB are nonspecific and less pronounced in the elderly. Diagnostic difficulties in the elderly are common in many diseases but it is important to use all possible techniques to make a microbiological diagnosis. Recognising frailty to prevent loss of independence is a major challenge in dealing with the therapeutic aspects of elderly patients. Several studies report contrasting data about poorer tolerance of TB drugs in this population. Adherence to antituberculosis treatment is a fundamental issue for the outcome of treatment. Decreased completeness of treatment was shown in older people as well as a higher risk of treatment failure.

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Advances in Treatment of Latent TB Infection: What Is the Latest Approach to Treat Latent TB Infection to Prevent Pulmonary TB?

Ghassemieh

Narita

2022

Respiratory Disease Series: Diagnostic Tools and Disease Managements

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Tuberculosis in Older Adults: Seattle and King County, Washington

Cited by 13 publications

References 14 publications

Pulmonary Tuberculosis in Older Adults: Increased Mortality Related to Tuberculosis Within Two Months of Treatment Initiation

Pulmonary Tuberculosis in Older Adults: Increased Mortality Related to Tuberculosis Within Two Months of Treatment Initiation

Tuberculosis in the Elderly

Advances in Treatment of Latent TB Infection: What Is the Latest Approach to Treat Latent TB Infection to Prevent Pulmonary TB?

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